Tuesday, September 17, 2013

Is this the most bizarre bad doctor of all?

There seems to be no shortage of bad doctor stories going around right now. Just when you thought you'd heard the worst, along comes another.

A "cosmetic surgeon" in California has lost his license to practice medicine and has been charged with involuntary manslaughter in the 2010 death of a 61-year-old woman during a 10-hour liposuction procedure being done in his office. She apparently died from an overdose of lidocaine, fentanyl and oxycodone.

Like some other cases involving doctors who lost their way, this physician trained at renowned institutions. In this case, the doctor was described as having done a residency at Columbia, a chief residency at Johns Hopkins and a fellowship at MD Anderson Cancer Center. 

His training was in obstetrics and gynecology, and he was not certified by a legitimate American medical board. He called himself a cosmetic surgeon but apparently had no formal training in cosmetic or plastic surgery.

Here is a list of some of the other major issues with this doctor.
In addition to the manslaughter charge, he was charged with elder abuse of a 77-year-old woman who also had complications during liposuction.

He charged patients exorbitant fees for procedures, allegedly as high as $650,000, but routinely in the range of $50,000 to $100,000.

He once anesthetized a patient for surgery, and while she was sedated, had her sign for more surgery at an increased fee.

He offered discounts to patients if they would enroll in a Harvard University study, which was later proven to be fictitious by Charles Feldman, a persistent investigative reporter for a Los Angeles radio station.

He is currently in jail, having been tried and convicted of attempted grand theft for trying to sell $20,000 worth of medical equipment he did not own.

The California Medical Board was warned about him by other surgeons two years before the death of the liposuction patient.

He has been living illegally in the United States since his visa expired in 2006. Apparently the California Medical Board and most other boards do not check on things like visa status when doctors apply for or renew licenses.

After the death of his patient and the restriction of his license to non-invasive procedures, he started advertising his services using only his first name so that Internet searches would not reveal his licensing problems or stories about the patient who died.

At some point near the time of the liposuction patient's death, the doctor was rushed to a hospital from his office having called an ambulance when complications arose while attempting to perform a hernia repair on himself. The homicide detective who investigated the case said, "That caused me to question whether [the doctor] was in complete control of his faculties."

It is ironic that he even botched the surgery he tried to do on himself. He should never have believed his own advertising, nor should anyone else have.

Once again, this doctor could have been stopped before that liposuction patient died, but the medical board did not act.

It is sad for the patients and the families he harmed. 

PS: His Healthgrades score today is 4.4 stars.


Anonymous said...

I live and work in CA, where Medical Board disciplinary actions are published quarterly and all details are readily accessible even by the general public. From what I see, many of the actions are against bad behavior not directly related to patient care (DUI's, domestic violence, poor record keeping). Others are against sexual exploitation of patients. Few are matters of pure clinical incompetence.

Now, obviously sexual miscreants should be drummed out. And perhaps alcoholic doctors should be exposed (not sure if they don't treat patients while under the influence), but surely the number one focus should be clinically dangerous docs.

Libby said...

to paraphrase the lawyer quip: the patient who operates on himself has a fool for a patient and an ass for a surgeon.

Wonder what he was like as a Ob/Gyn...drops babies?

Skeptical Scalpel said...

Anon, I wasn't able to find out what, if anything, the California Board did when they were warned about this doctor in 2008.

Libby, the only good thing is that he left the practice of OB/GYN.

Anonymous said...

I think the main thing is how do we get people like this out of medicine, while at the same time balancing those docs who truly shouldn't be disciplined? I think we need to make a difference between those docs who
a) just don't truly keep up with skills (and I can think of a few),
b) those who need education on bedside manner/team playing skills (every MD - because even radiologists have to work with others),
c) overloaded,
d) make a first mistake like everyone (DUI at .07 & the limit is .06),
e) poor record keeping

and those who truly have to be booted out of medicine. Any kind of sexual advances, cut off someones' wrong leg, and basically malpractice/malfeasance type of stuff like the hernia operation, they're just out. Plus, once they're out, it goes to ALL state boards and they lose any medical privs any where in the US & territories.

Is that something docs would agree to? I mean it leaves in protections but at the same time you nail those who make everyone who spent a lifetime dedicating themselves to the health profession not look like garbage.

Looking for what would be the best of worlds ...

Anonymous said...

I will never EVER believe those rating sites again.

I don't understand how he got dozens of rave reviews. Can a doctor do great work on some patients, then regress to lousy or criminal work on others?

Here is a link to the latest Cal. Medical Board decision on this doctor. It's a 41 page indictment listing charges such as gross negligence, incompetence, false advertising, lack of informed consent, unqualified staff, layperson monitoring anesthesia and on and on.


more info:



Emily (skeptical patient)

Skeptical Scalpel said...

Anon, one of the many problems with ratings is that someone with a nice personality will get rave reviews. Online ratings say nothing about quality. It's not clear how to measure quality anyway.

Skeptical Scalpel said...

Other anon, your suggestions are quite good. They make sense. That's probably why they will never be adopted.

Karen RN said...

I think if this "doctor" had any success it was dumb luck. For all we know, he wrote the reviews himself. I agree w/SS and Anon: the guidelines are excellent and not likely to happen. There are plenty of bad actors out there who would fight tooth and nail to keep them from being adopted. Ironically, they would never put that much effort into their practice.

Skeptical Scalpel said...

Karen, you are right. He may have just been lucky or he was doing cosmetic surgery, which at least is not usually life-threatening.

It's a good point. He may have written the reviews himself. He certainly would not have hesitated to do that.

artiger said...

I wonder if he wrote a review on himself after his attempted hernia repair?

Charlotte said...

I know many people who are on Medicaid, and their care can be awful -- yet they think it is wonderful. If each twinge or pain is treated with meds and often surgery, they sing praises about their doctor. The less care they get, the worse the doctor, in their opinion. They are overtreated and overmedicated -- but happy, very happy.

Skeptical Scalpel said...

Art, if he wrote a review of himself, I am sure it was good.

Charlotte, I agree that a happy patient may not always have received the best care. It's a huge issue with patient satisfaction, which has been shown to not indicate quality.

Anonymous said...

"I think the main thing is how do we get people like this out of medicine, while at the same time balancing those docs who truly shouldn't be disciplined? I think we need to make a difference between those docs who
a) just don't truly keep up with skills (and I can think of a few),
b) those who need education on bedside manner/team playing skills (every MD - because even radiologists have to work with others),
c) overloaded,
d) make a first mistake like everyone (DUI at .07 & the limit is .06),
e) poor record keeping"

It gets complicated:

a) not keeping up with skills leads to clinical incompetence, no?

b) docs aren't disciplined for simple rudeness. The cases I've read cited physical abuse or repeated acts of intimidation. Also, in my experience radiologists actually are way above average in team skills and bedside manner. They may have scant direct patient contact but they are interacting with other docs all the time.

c) no excuse that I can see

d) In CA the average blood alcohol level for someone arrested for a DUI is 0.15 - almost twice the per se legal limit. So most arrestees (including docs) are completely drunk. Should this be something investigated by the Medical Board? I don't know.

e) "Poor record keeping" is seldom an independent accusation, but tacked onto more egregious violations.

Skeptical Scalpel said...

Anon, good points. I can't argue with your comments.

Anonymous said...

In over 30 years of nursing leadership, it has been my very good fortune to know a large number of extremely competent, dedicated and caring physicians. I have also known enough physicians who are none of the above to frighten an average lay person into never seeking medical care if they knew what I know. What never ceases to amaze me is the level of tolerance we as a society have developed around this issue.

I have seen repeated events of patient harm or death that were directly attributable to physician incompetency or purposeful inappropriate actions, and yet rarely to never see said physicians suffer the consequences of that behavior. On the other hand, other health care professionals can be (and frequently are) fired, subjected to licensure discipline and sometimes criminal prosecution for behaviors that may not even rise to the level of some of the more striking physician behaviors I have seen. Lest you think I am crying foul on behalf of those other professionals, let me be clear that I have been the responsible leader in several of those instances, and I do not hesitate to move forward with such if warranted by the facts of the case.

Doctors are just like everyone else. There are good and bad examples to be found everywhere. What perplexes me is that health care continues to accept a model that annoints every physician with a new license and a halo when they graduate from medical school, and allows physicians to "police" themselves through peer review and medical licensing boards, when it has been repeatedly demonstrated to be an ineffective mechanism. There is plenty of evidence to support the position that standards of medical practice and behaviors should be subject to a more stringent standard of performance appraisal and accountability.

Patients are at the bleeding edge of the harm that ripples throughout the health care system when physicians are allowed to walk away from inappropriate behaviors with nothing more than a slap on the hand (if that). It is time for meaningful change in the oversight structure of physician practice.

Skeptical Scalpel said...

anon, I appreciate your heartfelt thoughts. My purpose in writing this post was to raise awareness of the very problem you describe. Until states start putting some effort and money into policing doctors, nothing will happen.

Anonymous said...

I reported a physician many years ago and the medical board is still letting him practice. Some of the cases I reported resulted in death after I informed them of his dangerous practices. I can't help to think that those patients would still be alive if the medical board had done something sooner.

Don't even get me started on elder abuse - among the many allegations I made, I also reported him for "tricking" elderly patients into getting procedures they knew nothing about, yet he got away with it. I suppose elderly patients don't make good witnesses, since they get confused over details. I'll never forget elderly people coming in for a pre-op exam for a procedure they knew nothing about. They said someone from the office called "out of the blue" and told them the doctor needed to see them ASAP. One patient even said that she trusted Dr. X, so if he thought she needed a procedure, then she must need it. Never mind that she wasn't in pain and hadn't even been seen by the doctor in 2 years. The stories I could tell you would boggle your mind.

He claims he's being targeted by the medical board...well I HOPE he is after everything he has done! God knows physicians in the community have complained about him to each other for years. His lawyers keep dragging this out - he even sued the medical board for harassment. Hopefully, his license will be toast soon. Even then though...he should be sitting in jail.

Skeptical Scalpel said...

Anon, sounds like a very frustrating situation. you did everything you could. Keep us posted.

Anonymous said...

i often do use those online doctor reviews...which are popular polls. I wish you could say how you define an excellent doctor. When they are asking you how was the office, waiting time. why not ask something like did you feel you were heard well? listen too etc.
I do check state information. I was glad to see that only psychiatrist in this area for many years( loved by many non patients) had been busted for breaking insurance rules/laws in my state and another. He was suspended and fined. He still is not seeing every patient as required by insurance. When he does, 1 minute, how are you?. Joke!!
His PA, was 1st class pill pusher. I can go on about how terrible but i will get to the point.
Is there anyway other than word of mouth to find a good doctor, both PCP and specialist. I been trying to find one in Rheum and seen 4 doctors. 3 are okay, 1 was very bad...i am upfront from my 1st ph call to the office on what i expect. I say it to the dr when i first met them..i want to be treated as partner in my healthcare...so we discuss options for drugs/tests etc but bottom line is my decision.
All agree, but start ordering a lot of tests and drugs..i do not want to be on a lot of drugs..this is in Rheum dept so not mental case.
Are there any sites anyone would recommend? i tried non profit organizations..not much luck if any. part is i live in very rural area
appreciate any help by anyone

Skeptical Scalpel said...

Anon, thanks for commenting. I don't know of another way to find a good doctor other than word of mouth. If you've read any of my stuff, you know I don't trust online ratings.

Anonymous said...

The Texas Medical Board has done it again. They filed several formal complaints against a pain management physician at SOAH, but then dismissed all but one of them. So, the physician went from almost losing his license to having to do an upgrade on his EMR and paying a $2,000 fine. No one can believe it - everyone assumes he paid someone off. Please read the formal complaints filed against him and then read the board order. The physician's name is Ryan Potter.

If the Texas Medical Board isn't going to discipline physicians, then it's only a matter of time before we abolish tort reform.

Skeptical Scalpel said...

Anon, I read the material. It is hard to believe. I have a friend in Texas who was misdiagnosed by a doctor. It's a slam dunk winner of a malpractice case. He can't get a lawyer to take it on because the damages are not likely not high enough to make it worth the lawyer's time.

I agree that Texas might be a good example of why tort reform doesn't always work.

For others reading this: SOAH stands for State Office of Administrative Hearings.

Anonymous said...

This gent was convicted of involuntary manslaughter in California in 2011. He performed a gallbladder surgery in an Inglewood home turned into a neighborhood clinic, using injected lidocaine for anesthesia.

"But Bonilla said he had performed that surgery, in such a lower-cost manner, safely about 200 times before without a problem."


Bonilla was allowed to serve out his sentence on weekends.

Skeptical Scalpel said...

Wow. That is some story. I wonder if he really did 200 cholecystectomies under local? And how did he make the diagnosis in all those cases? I can think of a lot more questions.

Anonymous said...

Shelly, RN
Wow, he makes Dr. Conrad Murray, Michael Jackson 's last Dr. look good.. Dr. Murray after
his early release, from jail, 2yrs served on a 4yr involuntary manslaughter conviction , (2013)
said on his release..(per TMZ , my great source)
he will seek relicensure in NV, AZ and ??maybe he will not get his California license back. Maybe , he can work for HHS, on the death panels.
tongue in cheek. Thank you , for your blog.

Skeptical Scalpel said...

I've written about a few bad ones, but this guy wins the prize.

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